- Discussion:
- indicated for chronic ingrown toe nails or for any condition in which the nail shape is thickened and distorted;
- Surgical Matriectomy:
- excision of matrix w/ scapel may be used but has high complication rate;
- for adequate exposure of the entire germinal matrix, two oblique incisions are made at the proximal edges of the nail fold;
- the nail fold is then flipped proximally;
- the distal nail bed including the superficial periosteum is removed;
- take care not to injure the extensor tendon;
- consider application of STSG or free nail graft;
- as an alternative consider using an extended V-Y distal volar flap (Atasoy);
- see V-Y distal volar flap;
- after the sterile and germinal matrix is removed, the flap covers the defect;
- Chemical Matriectomy:
- chemical destruction of the nail matrix is preferable to the scapel technique;
- this requires exposure of the entire target nail bed to the chemical in order to avoid remnant nail growth;
- note that the germinal matrix extends proximally to the metaphyseal flares of the distal phalanx;
- chemical agents:
- phenol alcohol (88% liquified): applied for 30 sec and is then wash out w/ isopropyl alcohol;
- silver nitrate: may be applied to granulation tissue;
- hydrogen peroxide (10%);